Meningioma dural sinus involvement

Alternatives for intracranial meningioma treatment of dural sinus involvement include:

▶ Superior sagittal sinus (SSS). If the tumor occludes the SSS, it has been suggested that the sinus can be resected carefully, preserving veins draining into the patent portions of the sinus. ✖ However, this should be undertaken with great trepidation since patients still not infrequently develop venous infarcts, probably as a result of a loss of minimal sinus flow and venous channels in the dura. Before ligating the sinus, the lumen should be inspected for a tail of a tumor within the sinus.

Partial occlusion of superior sagittal sinus:

1. anterior to the coronal suture, the sinus may usually be divided safely

2. posterior to the coronal suture (or, perhaps more accurately, posterior to the vein of Trolard), it must not be divided or else severe venous infarction will occur

a) with superficial involvement, the tumor may be dissected off the sinus with care to preserve patency

b) with extensive involvement:

● sinus reconstruction: hazardous. Thrombosis rate using venous graft approaches 50% and is close to 100% with artificial grafts (e.g. Gore-Tex) which should not be used

● it may be best to leave the residual tumor and follow with CT or MRI. If the residual tumor grows, or if the Ki-67 score is high, SRS may be used; SRS may also be used as initial treatment for tumors that are < 2.3–3 cm

▶ Transverse sinus (TS). A patent dominant TS must not be suddenly occluded